Lymphadenopathy

Causes

Appropriate Tests

Generalised

Review clinical features, Full blood count, Blood film, White cell count differential.

Causes generally are reactive to local or systemic disease or represent involvement with benign or malignant (primary or secondary) infiltration.

Consider lymph node biopsy (including FNAB) in some circumstances if the diagnosis is uncertain, or if confirmation is required.

Infection:

Viral

  • Infectious mononucleosis
  • Cytomegalovirus infection
  • HIV infection
  • Rubella

Bacterial

  • Tuberculosis
  • Syphilis (secondary)

Protozoal

  • Toxoplasmosis

 

Chronic lymphocytic leukaemia

 

Lymphoma (non-Hodgkin)

 

Hodgkin lymphoma

 

Connective tissue autoimmune diseases

 

Sarcoidosis

 

Infiltrative disease eg amyloid

 

Drug reactions, especially

  • Phenytoin
  • Primidone

 

Localised

Examine lymphoid drainage area for local lesion.

Consider the possibility that local lymph node enlargement represents the initial presentation of a disorder associated with generalised lymphadenopathy.

Consider lymph node biopsy (including FNAB) in some circumstances if the diagnosis is uncertain, or if confirmation is required.

Culture of biopsy material (including for acid-fast bacilli and/or fungi), if appropriate.

Regional lymphadenopathy

 

  • Hodgkin lymphoma

 

  • Lymphoma (non-Hodgkin)

 

Bacterial infection

  • Staphylococci
  • Streptococci
  • Cat scratch disease
  • Syphilis
  • Tuberculosis
  • Atypical mycobacterial infection

 

 

 


See under Mycobacterial infection

Metastatic neoplasia

  • Carcinoma
  • Melanoma

 

  • Dermatopathic lymphadenopathy

 

  • Giant lymph node hyperplasia

Lymph node biopsy.

  • Angioimmunoblastic lymphadenopathy

Direct antiglobulin test; Protein electrophoresis, IFE, Lymph node biopsy.

  • Kikuchi's lymphadenitis

 

Lymphadenopathy - specific sites

 
  • Mesenteric

 

  • Yersinia pseudotuberculosis

Yersinia sp Ab.

  • Adenovirus

Adenovirus Ab.

  • Inguinal (primary genital infection)

 

  • Lymphogranuloma venereum

 

  • Herpes simplex infection

 

  • Syphilis

 

  • Mediastinal mass

 

  • Hilar

 

  • Lymphoma

See Lymphoma (classification)

  • Sarcoidosis

 

  • Tuberculosis

 

References

See also Pathology Decision Support Tool:  Lymphadenopathy investigation